ArticleFrontiers in oncology2026
Association of preoperative CT-derived visceral adipose tissue index with synchronous metastasis and metastasis-free survival after curative-intent surgery in colorectal cancer.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: To evaluate whether computed tomography (CT)-derived visceral adipose tissue index (VATI) is associated with synchronous metastasis and metastasis-free survival (MFS) after curative-intent surgery in colorectal cancer (CRC). Methods: This retrospective two-center study included patients with newly diagnosed CRC who underwent abdominal CT within 1 month before diagnosis or initial treatment between January 2019 and December 2022 (n = 468; metastatic CRC [mCRC], n = 77; non-metastatic CRC [nmCRC], n = 391). For the synchronous metastasis analysis, mCRC and nmCRC were propensity score matched 1:1 for age, sex, carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), study center, and tumor location (77 pairs), and multivariable logistic regression was performed. For the MFS analysis, the surgical nmCRC cohort was stratified by sex-specific median VATI into low-VATI (n = 195) and high-VATI (n = 196) groups, and Kaplan-Meier and Cox proportional hazards analyses were performed. Among patients who developed postoperative metastasis (n = 96), an exploratory descriptive comparison was performed between early (≤ 2 years, n = 76) and late (> 2 years, n = 20) metastasis groups. Results: After matching, mCRC showed higher subcutaneous adipose tissue index (SATI), VATI, and visceral-to-subcutaneous fat area ratio (VSR) than nmCRC. VATI was independently associated with synchronous metastasis (OR, 1.110; 95% CI, 1.067-1.155; p < 0.001), whereas SATI and VSR were not. In the surgical nmCRC cohort, the high-VATI group had shorter MFS (log-rank p = 0.001). On multivariable Cox analysis, VATI remained independently associated with shorter MFS (HR, 1.017; 95% CI, 1.003-1.032; p = 0.021), together with CA19-9, CEA, N stage, and lymphovascular invasion (LVI). In the exploratory descriptive comparison, no statistically significant differences in body composition metrics were observed between the early and late metastasis groups. Conclusion: Preoperative CT-derived VATI is a reproducible opportunistic imaging biomarker associated with synchronous metastasis and shorter MFS after curative-intent surgery and may help refine risk stratification and postoperative surveillance in CRC, although prospective validation is required before routine clinical application.
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